Health and Social Care Bill

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Mr. Burstow: The Minister began his response by saying that he was not convinced of the need for the amendment. I have not been convinced by his arguments as to why it is not necessary to place specific requirements in the Bill. We have not gone down the route of a detailed and prescriptive amendment, because that that would have invited him to advance arguments with which I am familiar in Committees. Nevertheless, we gave the Government the scope to advance the cause of patients' interests. We would like to take stock of what the Minister has said. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Question proposed, That the clause stand part of the Bill.

Sir George Young (North-West Hampshire): I am grateful to you, Mr. Maxton, for calling me and observing a semblance of rank in these matters.

It is ironic that clause 4 of the Bill embraces the private sector in comparison with a rather more narrowly drafted clause which is perhaps more notorious. Nothing shows the change that has taken place in the Labour party over the past 30 years more than the fact that we have clause 4 of this Bill, whereas the last time I served on a Standing Committee under a Labour Government nearly 25 years ago we had a Bill that phased out pay beds from NHS hospitals—``The private sector must not be allowed to infect the NHS and must therefore be driven out.'' It is interesting to contrast that philosophy with paragraph 11.2 of ``The NHS Plan'', which reads:

    For decades there has been a stand-off between the NHS and the private sector providers of health care. This has to end.

Hear, hear to that. However, who is responsible for the stand-off?

On clause 4, there are a number of issues on which the Minister touched on which I should like to press him a little more. When the last Government were negotiating PFI deals, I had no idea that, sitting on the other side of the table, representing the hard-nosed bankers, was my hon. Friend the Member for New Forest West. How delightful it is to have him on one's side now. When the Minister explained what would have to be declared, he said that where the Secretary of State gave a guarantee, which he can do under proposed section 96C(2b), it would be declared in that year that it was made. Will he confirm that? The Secretary of State for the Environment, Transport and the Regions made a statement about the channel tunnel rail link which involved a Government guarantee. I think I am right in saying that, in those circumstances, that would score as public sector expenditure only if and when the guarantee was called. Will the Minister confirm that what he has said—that where the Secretary of State provides a guarantee, it will be declared at once—is consistent with the line that the Secretary of State for the Environment, Transport and the Regions took with the channel tunnel rail link?

Under proposed section 96C(1), the Secretary of State may form companies. Do the Government intend having a majority stake in any of those companies, or is it envisaged that they will have a minority stake, which would be the normal pattern?

Will the Minister clarify what appears in ``The NHS Plan''? Paragraph 4.11 refers to new local surgeries, which is what the clause is about. It states:

    The NHS will enter into a new public-private partnership within a new equity stake company—Lift—to improve primary care premises.

It continues:

    As a result of this NHS plan, up to £1,000 million will be invested in primary care facilities.

Does he really envisage that £1 billion will be spent through LIFT? If so, that is a substantial amount. If not, will he say what percentage of that £1 billion will come through LIFT, and whether that is on top of what was planned anyway, or is simply refinancing something that was to be provided in any event?

Will the Minister explain more about the decision-making process? If, as I envisage, the Government hold a minority stake and the private sector the majority stake, how can the Minister encourage investment in the more deprived parts of the country, which the private sector has not yet reached? What dialogue can the Minister engage in to encourage the drift of investment? Will the Secretary of State put on the table what is necessary to persuade the private sector to go there, or does the Minister envisage an alternative form of dialogue to achieve that?

I do not wish to prolong the debate. I welcome the clause and am trying to establish how it fits with section 96 of the NHS Act 1977. It does not fit at all, because section 96 has four subsections and the clause refers to section 96C. I understand that the only way to make sense of it is to refer to the unwieldy document before all members of the Committee. Out of interest, I examined section 97, which printed 20 lines of an Act, but crossed every single line out. I wonder what function was served by that exercise in bureaucracy. If the Minister can shed some light on the operation of the clause, I would welcome it even more enthusiastically than I have so far.

6.45 pm

Mr. Swayne: It is a great pleasure and honour to follow my right hon. Friend and quite proper to have given way to his rank. I shall not repeat any questions that he asked more eloquently and intelligently than I could, but ask one additional question. Insofar as the clause enables the Secretary of State to be a participant in the formation of companies, how will it be affected by EU purchasing and procurement rules? I look forward to hearing the Minister's response.

My right hon. Friend the Member for North-West Hampshire provided me with a brief from the Democratic Health Network—an organisation of 80 members, the majority being local authorities, but primary care groups and trusts, community health councils and trade unions are also involved. It seems that clause 4 has not been universally welcomed. The brief points out:

    This short clause allows for a radical change to the way in which NHS services and facilities are financed. If the provisions in the clause were exploited to their full extent, most of the NHS could be financed through PPP. It will affect service users, patients, employees and wider communities. It is likely to be challenged by those who believe that public private partnerships are a ``back door'' way of privatising the NHS and neither provide value for money nor are sufficiently accountable.

The brief goes on to state the deep concerns of many people about the clause. Of course, I do not share those concerns. The Conservatives support the principles behind the clause, but it would be remiss not to have drawn the Committee's attention to those concerns.

In some ways, sitting in Committee today has been a surreal experience—a feast without Banquo's ghost. This morning, we had the spectre of health authority boards being dismissed and replaced entirely by the private sector—a spectre that the Minister failed to dispel. This afternoon, provisions on new, exciting arrangements with the private sector are being spelled out in the clause, yet we have not heard a peep from Labour Members. Perhaps that is a consequence of the ruthless way in which those who participated in the Second Reading debate have been excluded from the Committee. I leave hon. Members to think about that.

Lorna Fitzsimons (Rochdale): The hon. Gentleman knows that some of us spent most of our time in the corporate sector and have therefore no problem working, or identifying the excellence, within it.

Mr. Swayne: That begs the question, where was the hon. Lady on Second Reading? Others, who were not quite so involved with the corporate sector to which she so lovingly refers, made their feelings plain. It would have been interesting to hear those views reflected in the Committee. I am disappointed that a voice has had to be given to them by Opposition Members. Perhaps it is worth reflecting on that.

Mr. Denham: I shall deal directly with the series of questions raised by the right hon. Member for North-West Hampshire.

On when the guarantee would be declared, my understanding is that it would form a contingent liability and would be declared in the financial year in which it was made. However, I am not an expert in that area. I shall look further into whether it scores as public expenditure in that year or only the year in which the guarantee was actually caused. I shall write to the right hon. Gentleman and copy the letter to members of the Committee.

It is certainly our intention to take a minority stake in LIFT, as the Secretary of State, in partnership with Partnerships UK. We believe that LIFT will be able to produce £1 billion over the period that we have set out. That will make a major contribution towards the planned refurbishment of primary care premises and the development of new premises. It is our intention that the existing streams of funding will continue at the levels which are available, so this will not become a sole or exclusive route to the refurbishment of GP premises.

As for the ability to attract LIFT into the areas where it is needed, clearly the Secretary of State has a number of tools at his disposal, including the shareholding in the company and the NHS resources that could be put into, or that already exist, within areas. A planned approach to the refurbishment of a number of different premises enables us to bundle together a variety of different properties and development opportunities in one place in a way that most purely private sector companies would find difficult to achieve.

On section 97, I apologise if the document is hard to read, but as we discussed on the first day, my officials have made strenuous efforts to be as helpful as possible to the Committee in having a consolidated version of the legislation. I noted with interest the comments made by the hon. Member for New Forest, West on the Democratic Health Network. I should not mislead the Committee: we have done this primarily to get LIFT under way, but it is possible to envisage areas where significant capital investment would be required in the NHS and where a similar model could be used in the future.

Question put and agreed to.

Clause 4 ordered to stand part of the Bill.

Clause 5

Income Generation

Question proposed, That the clause stand part of the Bill.

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Prepared 23 January 2001